Departments Get Specific About Contraceptive Coverage in New FAQs

Chris Allesee

As a parent, I have learned the value of providing very specific directions. For example, if I tell my 3-year old to get her “shoes” to go play in the park, she will always grab her favorite snow boots. Technically, she complied with my request, but it clearly wasn’t what I meant. I know that I should have asked her to get her “sandals or sneakers,” but sometimes, I still find myself outwitted by a toddler. The recent FAQs issued by the IRS, DOL, and HHS addressing the range of coverage for contraceptive methods that must be covered by health plans under the ACA preventive care mandate has a similar vibe.

First, the Departments issued regulations in 2012 providing that health plans subject to ACA must cover preventive services for women at no cost based on guidelines issued by the Health Resources and Services Administration, which includes FDA-approved contraceptive methods. Then, the Departments released FAQs in 2013 providing that plans must offer the “full-range of FDA-approved” contraceptives, but may also use reasonable medical management techniques to control costs (e.g., requiring the use of generic drugs). The Departments should know better than to throw around generic terms like “full-range” on an issue as sensitive to employers as coverage for contraceptives and expect all plans to cover exactly what they want.

The new FAQs clarify that “full-range” means that plans must provide coverage for at least one form of contraception in each of the (currently) 18 methods identified by the FDA, but may use reasonable medical management techniques within each method. Having learned their lesson, the Departments also clarified that the process of requesting an exception to a medical management restriction should be transparent and not overly burdensome, and the plan must defer to the medical provider’s determination that an exception is medically necessary. Fortunately, the Departments recognized they asked for “shoes” in their first round of guidance, and will not enforce these new requirements until the first plan year after July 10, 2015 (for most, that means January 1, 2016). This gives plans that do not cover at least one form in each of the FDA-approved contraceptive methods time to make the changes.